MEDICARE: LISA ELLIS LPC, LCADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	37PC00786200	NJ
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	37LC00236900	NJ
3	101YM0800X	Mental Health Counselor	37AC00328500	NJ

General Provider Information

NPI Number	:	1750948683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ELLIS LPC, LCADC

Provider Business Mailing Address
First Line	:	107 PATERSON AVE
Second Line	:
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604-1414
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 PATERSON AVE
Second Line	:
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604-1414
Country	:	US
Telephone Number	:	551-900-1496
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2019
Last Update Date	:	10/18/2021

Similar Medicare Providers

1619991031 — SHAWN MICHAEL KOTLYN CRNA
Practice Location Address:

1414 HONEYGOLD LN
BROADVIEW HEIGHTS, OH
44147-3630

Practice Phone: 440-570-4022
Practice Fax:

1235364506 — LEENA LAFORTE PHARM.D.
Practice Location Address:

1414 MULFORD RD
GRANDVIEW HEIGHTS, OH
43212-3403

Practice Phone: 914-588-7409
Practice Fax:

1396018073 — MS. THEMA A MAWUSI-EL
Practice Location Address:

5110 CATO ST
MAPLE HEIGHTS, OH
44137-1414

Practice Phone: 216-518-9698
Practice Fax:

1750656518 — MS. JILL DAWN MCGILL
Practice Location Address:

5898 S ROBERT TRL
INVER GROVE HEIGHTS, MN
55077-1414

Practice Phone: 651-450-5965
Practice Fax:

1861882516 — ROSEMARIE ELAINE WILLIAMS LPN
Practice Location Address:

11558 232ND ST
CAMBRIA HEIGHTS, NY
11411-1414

Practice Phone: 718-525-8892
Practice Fax:

1760839427 — SHAYLONNA GLENN
Practice Location Address:

8268 RIVERVIEW ST
DEARBORN HEIGHTS, MI
48127-1414

Practice Phone: 313-974-8933
Practice Fax:

Directions to “ LISA ELLIS LPC, LCADC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.